Neuropsychological Assessments and Tests

Explore the tools of Neuropsychologists

If a person suffers a stroke, will he or she be able to drive again? Go back to work? Cook? Clean? Pay the bills? Will he or she be able to resume daily living on the basis of what society considers “normal daily functioning?

What about the returning soldier from war who a has traumatic brain injury, or the person involved in a car crash incurring injury to the head - or the person recently diagnosed with a brain tumor? How do doctors, neuropsychologists, and all those involved in a patient’s diagnosis, treatment, and rehabilitation planning answer these questions?

The answer usually involves a neuropsychological “assessment” involving the administration of several neuropsychological “tests.”

Neuropsychological Assessment Progression

Before neuroimaging technology became available in the middle of the 20th century, assessing individuals through “tests” for possible brain injuries and diseases was the sole means of diagnosis. But now that neuroimaging devices usually “diagnose” areas of brain damage, brain tumors, and various types of brain diseases with high degrees of accuracy, the purpose of neuropsychological assessments has shifted.

Today, a neuropsychological assessment usually means administering a battery of tests to determine a patient’s cognitive function after a diagnosis has been made. Assessment determines the cognitive and behavioral ramifications of brain deficits and abnormalities, predicting an individual’s chances for improvements in brain function, or worsening outcomes.

For example, will a patient with a brain tumor experience any cognitive deficits? If so, what will those deficits be? Neuropsychologists assess for cognitive consequences such as loss of memory, language impairment, or the ability to plan, execute, and terminate certain acts and processes – such as those needed to function in work settings.

Assessments are also used to determine behavioral and sensory consequences of brain abnormalities. Has the patient started exhibiting socially inappropriate behaviors, or exhibited mobility problems? Is he or she able to drive a car? Is vision affected?

In addition to assisting healthcare providers, neuropsychological assessments are also used by lawyers and the courts in determining financial compensation awards for clients hurt in accidents.

Specially designed tests are the main tools used in nearly all forms of neuropsychological assessment. However, the combination of neuroimaging devices and technologies plus assessment is becoming more widely available. For instance, if an assessment is used to determine a particular cognitive function, such as the ability to speak and understand written and spoken words, neuropsychologists can test these skills as an individual undergoes a non-invasive brain scan. This type of simultaneous testing can provide invaluable information about a patient’s deficits in addition to locating damage in the brain. (For more information on neuroimaging technologies, see Neuroimaging.)

Neuropsychological Tests

Neuropsychological tests not only attempt to measure the degree and severity of brain abnormalities, but also try to predict how individuals will function in their “real lives” given the injuries, deficits, or degrees of decline. The tests are also used to track the progression of a disease, and plan rehabilitation treatments and programs.

The Rorschach Test

One of the more well known neuropsychological tests is the Rorschach test, also called the Rorschach inkblot test. Created by Hermann Rorschach, the test uses images of inkblots to elicit spontaneous responses from individuals. These responses supposedly represent the innermost thoughts of individuals, revealing personality traits that are otherwise too hard to measure any other way.

Some psychologists believe that this test reveals dysfunctional cognitive processes. Other psychologists claim that significant problems exist in administering the test, believing that testers can be biased in both giving the test, and in interpreting the responses. For these reasons, many question the test’s validity and reliability.

However, the test is still used among many in the field of Neuropsychology. Usually it is given with a series of other tests, or a battery of tests, and the results are measured and synthesized with the results from all the tests.

A large number of reliable and valid neuropsychological tests exist, giving those performing assessments a large number of options from which to select. A series of tests, called a “battery,” are often given to a patient to try and comprehensively cover all possible areas of impairment.

One example of a series of comprehensive neuropsychological tests is the Halstead-Reitan Neuropsychological Test Battery. A massive assessment taking five to six hours, the Halstead-Reitan consists of eight separate tests measuring a number of brain and nervous system functions, including:

Verbal skills

Spatial and sequential perception

An ability to form mental concepts, analyze information, and make judgments

A number of the tests are quite simple. For example, one of the tests to measure motor output only requires patients to use each of their fingers to tap a pad sensitive to touch.

Another test evaluating auditory attention and concentration uses 30 pairs of tape-recorded sounds. Patients simply have to determine if two sounds are the same or different.

Yet another test determines if patients can’t perceive stimulation on one side of the body when both sides are stimulated simultaneously. This test attempts to measure the severity of a brain disorder affecting one side of the brain.

Similar to all batteries of neuropsychological tests, if a patient performs poorly across all tests, a brain disorder affecting a large area of the entire brain is likely, such as in dementia. However, the inability to perform one or two specific tests most likely localizes brain deficits or impairments to one area or region of the brain.

However, a large battery of tests is often not an option for many patients who simply can’t sit that long, or maintain their attention and focus. In those cases, neuropsychologists customize test batteries or use less extensive testing tools.

Here’s a short list of some of them more common neuropsychological batteries and tests:

Ammons Quick Test

CANTAB (Cambridge Neuropsychological Test Automated Battery)

Dementia Rating Scale

Finger Tapping (Oscillation Test)

Halstead-Reitan Neuropsychological Battery

Luria-Nebraska Neuropsychological Battery

Kaufman Short Neuropsychological Assessment

Rorschach Test

Tower of London Test

Weschler Adult Intelligence Scale (WAIS)

Word Memory Test

If you are interested in the science of thinking and behaving, in how the brain facilitates the acquiring, processing and using of information, and how brain injury and disability affects normal functioning, you should consider a career in neuropsychology.

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